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The Book Doctor Is In

Today, I’m pleased to be launching a weekly column on this blog devoted to answering medical-related questions writers have been asking that pertain to characters or stories they are writing, books they are reading, or TV shows/movies they are watching. Since my medical background and cases inspire ideas for my own books, I would like to help other writers and readers understand more about common and unique medical maladies.

Q. I am writing a book that is set in 19th Century New England and my lead character suffers from insomnia and stress. From books I’ve read, it seems that doctors in that era frequently prescribed laudanum to alleviate these symptoms. Can you tell me more about this drug and its side effects? Vicky, NYC

A. Laudanum is also known as tincture of opium. It is 10% opium and 90% alcohol, usually with a flavoring added to mask its bitter taste. Obviously the 180 proof had an effect outside the opium. It was probably invented in the 16th century and its name comes from the Latin laudare, to praise. Laudanum has strong analgesic properties and was used for many purposes ranging from menstrual cramps to colic in babies. It was used recreationally as well. By the 19th century, laudanum was in popular use without a prescription. In addition to characters in novels, like Sherlock Holmes, it was used by authors themselves, among them Sir Arthur Conan Doyle, John Keats, Edgar Allen Poe, Lewis Carroll, and even Charles Dickens. Laudanum has side effects that are typical of most narcotics, such as dependence, withdrawal, sedation, constipation, and death (from overdose). In the 20th century it was removed from the over-the-counter market, along with the cocaine in Coca-Cola!

Q. I’m a big fan of the TV show, House. Almost every week, when Dr. House and his team of experts are trying to figure out their patient’s baffling medical condition, “amyloidosis” is often suggested as a possible diagnosis. What exactly is amyloidosis? Stuart, Jersey City, NJ

A. Amyloidosis is a rare disease caused by an abnormal protein called amyloid being produced in the bone marrow. Abnormal antibody proteins can create amyloid deposits that build up in the bloodstream and damage any organ. They frequently affect the heart, kidneys, and nervous system. There are various forms and because it is rare and difficult to diagnose, amyloidosis is generally incurable. Symptoms can range from changes in color/texture of skin, swelling in ankles and legs, numbness in hands or feet, fatigue, and shortness of breath–symptoms indicative of a variety of other illnesses. I check for it in my patients because it can cause peripheral neuropathy. Not thought to be contagious, one of my neurology professors, who studied it extensively, performed numerous biopsies on patients who died from it, actually (and sadly ironically) died from it himself! Those of us who do procedures always eventually stick or cut ourselves while treating patients. The movie Puncture deals with some of the dangers of modern medicine.

Attention writers! If you’re working on a book or script and need quick insight or advice on a medical condition that affects a character or impacts a storyline, please email your question to fritz@fritzstrobl.net. I’ll post answers to two questions every Monday on this blog!

Please note: due the volume of requests received, I am not able to provide personal responses, nor can I answer questions regarding personal health. If you have a question or concern about a health issue, please contact your doctor.

Migraines sound pretty boring as a blog topic. Actually they aren’t. I know. I take care of them. And I have them myself. And I named my first novel Presidential Migraines.

Migraines have been in the news this summer when it was leaked that Congresswoman Michelle Bachmann, a Presidential candidate, has them. The press claimed Ms. Bachmann might be laid up for days at a time and this could impact her effectiveness in the Oval Office. The story is almost certainly nefarious political fiction; these days migraines are well treated in the vast majority of people, be they Presidential candidates or anyone else.

Migraines affect 12% of the American population with 18% of females and 6% of males having at least one per year). Yet, they are clearly underdiagnosed, a core reason being that some people with migraines never get headaches. Estimates are 3%, but I suspect that is grossly low because most people don’t think they have a migraine unless it includes an incapacitating headache and head-in-the-toilet vomiting. To neurologists that would simply be called a bad migraine.

Take my migraines, which I never knew ran in my family for every known generation until I started asking questions. At age 27 as a G2 neurology resident at the University of Minnesota, I experienced spells where I thought I was going to pass out, couldn’t think straight, and was dizzy, but had no headache. To be sure that I wasn’t simply hypoglycemic, I had my blood checked. Normal. Same for CT and EEG. Then I spoke to Mom—often an excellent resource—and she clued me in on our family’s history with migraines. In fact, as I child, I had a few emergency room visits for possible appendicitis, which turned out to be abdominal migraines. This goes to show it’s not always in your head!

Hemiplegic migraines run in some families, where the sufferer becomes paralyzed on half his body (with or without a headache), almost like a stroke. Some get aphasic; they can’t speak or understand–or both–even though they know exactly what they want to say! This can also cause partial or total blindness (scotoma and hemianopsia). Some people even pass out–not from the pain either.

Certain foods and medications are known to be precipitants of migraines, such as cheese, chocolate, red wine, and hormones. If you’re prone to migraines, you may need to curtail or avoid consumption or usage altogether.

To this day I rarely get actual headache symptoms. On rare occasions, I may find myself reading the same medical report three times and can’t understand it–I recognize that to be a symptom of my migraines and simply take two ibuprofen.

If you suspect you have migraines and are concerned, you should seek the help of your physician or a neurologist. Neurologists are specialists who deal with migraines as well as other brain diseases.

While writing Greek Flu, I wanted to learn more about the Navy SEALs so that I could accurately portray them in my story. I was privileged during my research to meet a large number of active and retired SEALs. I wanted to know not only the technical details of what they did but also who they are. I was also able to meet some of their families and spend time with them. These days, after the bin Laden mission, there are a lot of SEAL “experts” who have come forth. I make no such claims, but have reviewed chapters of my book with some experienced SEALs for general accuracy; any inaccuracies are solely mine–either by intent or error. I believe my depiction of the SEALs in Greek Flu is factual and intriguing.

The Special Warfare insignia, or "SEAL Trident."

SEAL is an acronym for SEa, Air and Land. They are a group of men who take their job of protecting the United States to heart. The concept of “Team” really means something to them. During some meetings I was asked if I “was Team.” Hopefully that meant that I was at least holding my beer correctly. One funny story is that after meeting with all these brave men, my wife confided that her biggest fear was that despite my age I would somehow convince the Navy to let me be a SEAL!

SEAL history goes back to WWII when in 1942 the Amphibious Scout and Raider School was started in Florida. They trained the first Naval Combat Demolition Unit (NCDU) to reconnoiter land areas and dispose of obstacles. NCDU was first utilized in Operation Torch in North Africa. By 1943, after serious problems in Tarawa, the Navy realized the need for underwater demolition of obstacles. Eventually, nine Underwater Demolition Teams became Combat Swimmer Reconnaissance Units and, ultimately, Navy UDTs.

In the 1960s it was realized that the United States must development unconventional warfare with guerilla and anti-guerilla abilities. Mainly from UDTs with commando experience in Korea, modern SEAL units were formed with bases in San Diego and Virginia Beach. They were so effective that it was estimated that 200 Viet Cong were killed for every SEAL life lost.

Their many battles are beyond the scope of this page. But whether in Iraq, Afghanistan, or the latest hot spot, Naval Special Warfare continues to evolve and serve with the demands of the day, either alone or in coordination with other services branches, some of which attend SEAL reunions as well.

“Downtown. You were found wandering inside a coffee shop, confused, and without identification.”

“I remember nothing since I left home this morning. My memory is just blank.”

“Your husband is on his way. I called him a few minutes ago after you were able to recall your name and phone number for me. He said you pulled your car out of the garage, ran into the tree in front of your house, left it there, and then drove his car to your clinic. He said he had a day off so he slept in and has been trying to reach you ever since he realized something was amiss, but you left your purse, briefcase and cell phone in your car. You went to work, went through mail, charts and dictated letters. Your secretary said you seemed a little different–she thought something was definitely wrong when your dictations didn’t make sense. She said you went out for lunch and never came back. By that time your husband had called your office and the police brought you here, confused from the coffee shop.”

Transient Global Amnesia or TGA is a condition I diagnose in patients 2-4 times per year. There are many causes, but often none is found. Almost all patients have a full recovery, but in a few, the condition will recur. My first case was essentially the one described above–an MD whose TGA was caused by an unusual medication reaction. In almost all cases, patients function somewhat normally but their judgment is impaired and they make no memories.

My second case was a man who also wound up in the locked ward. He had a continuous epileptic attack but was able to talk to me reasonably well. He was confused, but fluent in speech. I went through my usual protocol of blood tests, an electroencephalogram (EEG), and brain scans. When I looked at the results of the EEG, I noticed that he was having continuous seizure activity, yet was not moving a muscle. I re-examined the patient to see if I had missed some shaking, eye twitching, or anything that might look epileptic, but I saw nothing abnormal. I gave him a large intravenous dose of a seizure medication. The next morning, he was totally recovered. He recalled nothing of the day before or of my examining him twice.

Other causes of TGA may include a large number of factors including migraines and various chemical abnormalities, as well as stroke-like problems. There are other patients who simply have psychiatric problems or feign the condition after perpetrating certain criminal acts or hoping to get an edge in legal cases.

Overall, Transient Global Amnesia is a fascinating condition that demonstrates the complexities of the brain and our limited understanding of what is the organ of the human body that we understand the least. The brain is the last frontier of medicine.